Cannabis dependence is the most common illicit substance dependence in the U.S. and people with cannabis dependence are highly vulnerable to anxiety disorders. The co-occurrence of anxiety disorders among those with cannabis dependence is a pressing public health matter given elevated anxiety is related to poorer cannabis treatment outcomes. Integrative models suggest that cannabis-related problems among those with anxiety disorders may be maintained by a reliance on cannabis to manage anxiety and cannabis withdrawal. Although effort has been undertaken to evaluate treatments for cannabis dependence and anxiety disorders in isolation, investigations of the treatment of these conditions when they co-occur have been virtually absent. Motivation enhancement therapy (MET) combined with cognitive-behavioral therapy (CBT) is an efficacious intervention for cannabis dependence, yet outcomes are highly limited for anxious patients. One novel and promising approach to treating anxiety disorders is the use of transdiagnostic anxiety treatments that facilitate the treatment of patients with anxiety psychopathology regardless of the specific type of anxiety disorder. One such treatment, False Safety Behavior Elimination Treatment (FSET), may be particularly useful with cannabis dependent anxious patients as it focuses on the elimination of behaviors that may be effective in decreasing anxiety in the short-term, but can maintain and even exacerbate anxiety in the long-term (i.e., false safety behaviors). The use of cannabis to manage anxiety can, therefore, be targeted in such a treatment. The objective of this project is to test the feasibility and utility of a novel, integrated approach to treatment of patients with cannabis dependence and anxiety disorders who use cannabis as a maladaptive coping strategy. Phase I of the proposed project will feature the development and refinement of a specialized group protocol (i.e., Integrated Cannabis and Anxiety Reduction Treatment or ICART) for integrating MET-CBT for cannabis dependence with FSET. MET will be used to increase motivation to quit cannabis, CBT for cannabis dependence to teach patients skills to manage high-risk cannabis use situations, and FSET will be used to teach patients skills to manage their anxiety. The initial protocol will be modified based on the experience gained in the treatment of two groups (6 patients each) with the integrated treatment. Phase II will be a randomized controlled trial examining the relative efficacy of the refined ICART treatment (n = 30) versus MET-CBT alone (n = 30). After post-treatment assessments, the ICART group will be followed for 3 months to examine maintenance of gains; the participants originally assigned to the control condition will be offered ICART. It is hypothesized that ICART will produce better outcomes than the control. Based on the outcome of this preliminary trial, the ICART protocol will be further refined and readied for larger-scale clinical trials. PUBLIC HEALTH RELEVANCE: Although people with cannabis dependence are highly vulnerable to anxiety disorders, and elevated anxiety is related to poorer cannabis dependence treatment outcomes, previous research has not examined how to effectively treat patients with co-occurring cannabis dependence and anxiety disorders. The goal of the current research is to develop and evaluate the feasibility of a specialized therapy for treating these persons. The overarching aim is to decrease cannabis use, cannabis-related problems and withdrawal symptoms, anxiety, and disability while simultaneously improving quality of life and examining possible mechanisms underlying treatment outcomes.